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General NPI Number Information
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NPI Number | 1760027445
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Entity Type | Individual
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Provider Name | SAMANTHA RENEE LYNES NCC, LCMHC, MHC, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2019
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Last Update Date | 04/20/2024
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Provider Practice Location Address
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Address Line | 11510 19TH AVENUE CT S
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City | TACOMA
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State | WA
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Zip | 98444-1434
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Country | US
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Telephone | 253-508-7857
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 LAKE TAPPS DR SE APT 104
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City | AUBURN
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State | WA
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Zip | 98092-8774
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Country | US
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Telephone | 253-508-7857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C8126
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 15260
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61261913
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License Number State | WA
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